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“These findings are in contrast to commonly held beliefs that patients with psychotic disorders have worse treatment outcomes,” wrote Rachel Lamont, M.D., of McMaster University in Ontario, Canada, and colleagues. “Our findings also raise questions about the routine exclusion of persons with psychotic disorders from trials of opioid substitution therapy, which may not be warranted or helpful.”
Lamont and colleagues analyzed data from 415 adults with OUD enrolled in community-based outpatient methadone maintenance treatment across Ontario. They used the Mini-International Neuropsychiatric Interview to identify participants with psychiatric comorbidities, including psychotic disorders on the schizophrenia spectrum, as well as other nonpsychotic disorders, such as major depression, anxiety, and bipolar affective disorder. Urine drug screening took place at three, six, nine, and 12 months.
Thirty-seven participants were identified as having a comorbid psychotic disorder, while 378 had at least one comorbid nonpsychotic disorder.
The authors found that 81% of the patients with psychotic disorders remained in treatment for OUD at 12 months, a rate comparable to the 84% of patients with nonpsychotic disorders. They also found that having a psychotic disorder was associated with fewer positive opioid drug screenings.
Additional findings include the following:
- Participants with psychotic disorders on average received a higher dose of methadone than those with other psychiatric disorders.
- Participants with psychotic disorders were more likely to also be taking antidepressants, antipsychotics, benzodiazepines, and/or mood stabilizing medications compared with participants with other psychiatric disorders.
- Less than 50% of participants with psychotic disorders were prescribed antipsychotics.
Methadone maintenance therapy, the authors noted, “is not without risks,” and the use of higher doses of methadone among those with psychotic disorders “has important safety implications.” Additionally, “the low rate of prescription of antipsychotic medications may also point to unmet diagnostic or treatment needs.”
For related information, see the Psychiatric News article “Medications Can Help Patients With Substance Use, Psychotic Disorders.”
(Image: iStock/Minerva Studio)
How to Participate in 2020 Minority and Underrepresented Group Caucus Election
The Caucus of Asian-American Psychiatrists is holding an election for three leadership positions: president, Assembly representative, and Assembly deputy representative. To be eligible to vote in the election, APA members must join the caucus by Wednesday, April 1. Find more information on how to join the caucus here.